NPI | 1619926177 |
---|---|
Former Name | LAURA NOEL BEVERLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 043094) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 043094) |
207Q00000X Family Medicine (Licence: WA MD60541847) | |
Enumeration Date | 2006-05-10 |
Last Update Date | 2023-10-06 |